Abstract: PO0954
Novel Transitional Care Unit Design Achieves >50% Home Dialysis Choice in Incident ESRD Patients
Session Information
- Home Dialysis: Disparities and Modality Choice
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Diaz, Arley, UMASS/Baystate, Springfield, Massachusetts, United States
- Braden, Gregory Lee, UMASS/Baystate, Springfield, Massachusetts, United States
- Landry, Daniel L., UMASS/Baystate, Springfield, Massachusetts, United States
- Mulhern, Jeffrey, UMASS/Baystate, Springfield, Massachusetts, United States
Group or Team Name
- Kidney Care & Transplant Services of New England
Background
In 1983 Eschbach reported that a 6 station Home Dialysis (HD) Oriented Unit at Northwest Kidney Center had a 62% success rate in incident ESRD pts choosing HD.The RVCARE study of intensive in center HD education during routine thrice weekly dialysis had 38% of pts chose HD. Satellite Dialysis found that with their Transitional Care Unit (TCU) 30 % of pts chose HD.
Methods
We designed a 6 station dedicated TCU staffed with the added benefit of its main teaching nurse having 4 years each of being a home hemodiaysis (HHD) & peritoneal dialysis (PD) nurse coordinator. The unit contains 3 NxStage & 2 Liberty Select Peritoneal cyclers. Pts are dialyzed 4 times weekly on the Nxtage or eventually the cycler . Added support is given by dialysis nurses trained in HHD & PD as are the social worker and dietitian educators. Intensive education with a defined curricula in all forms of HD are given including shared decision making with families. A medical director highly skilled in HD therapies also re-enforces the education delivered by the entire team every week. All 67 of our pts starting dialysis since July 2020 received standard dialysis education with several phone or virtual education sessions from our outpatient CKD coordinator, description of the TCU, plus a home visit by one of our HD coordinators.
Results
Since July, 2020 67 pts have started ESRD therapy, with 35 choosing not to enter the TCU and 32 choosing the TCU. Only 7 of 35 pts educated the standard way chose HD, 4 PD & 3 HHD but 17 TCU pts out of 32 chose HD, 10 HHD & 7 PD, 53% , p=.004 compared to standard education. There were no signiicant differences in duration of nephrology followup, age, sex or causes of ESRD between the 2 groups.
Conclusion
We conclude: The success of our TCU is due to it design using: 1) Pre-ESRD educaton about the benefits of starting dialysis in a TCU & 2) Most importantly having a skilled and experienced home HD and PD nurse coordinator to be the main educactor and pt champion for both HHD adn PD. 3) Utilizing a HD skilled medical director & social worker using shared decision making adds confirmational education on the benefits of HD.
Funding
- Clinical Revenue Support